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INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION
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INSPECTION
FORM# REMARKS
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EHS-106-Rev.06101 INSPECTION REPORT STATE OF CONNECTICUT Jr ROUTINE INSPECTION ❑ REINSPECTION
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH ❑ PREOPERATIONAL ❑ OTHER
410 Capitol Avenue,MS#51 FDP,Hartford,CT 06134
NAME OF `` �^ ESTABLISHMENT
ESTABLISHMENT e.0.51d� U Ou�h�- (0)A kyjed Po.rki,o CLASS
STREET ADDRESS G 1'1age' 9A TOWN S6L,?y W-rIV �OWNER or fINSPECTION
OPERATOR DATE and TIME S oR`7 V Vl
Based on an inspection this day,the items marked below identify the violations in operation or facilities which must be corrected by the date specified below.
SOURCES OF FOOD EQUIPMENT&UTENSILS:CLEANLINESS VERMIN CONTROL
1 Approved source,wholesome, 4 21 Preflushed,scraped,soaked and racked 42 Presence of insects/rodents 2
nonadulterated 22 Wash water clean,proper temperature 1 43 Outer openings protected against entrance of 1
2 Original container,properly labeled 1 23 Accurate thermometers provided,dish basket if used insects/rodents
24 Sanitization rinse(hot water-chemical) 2
FOOD PROTECTION 25 Clean wiping cloths 1 FLOORS,WALLS&CEILINGS
3 Potentially hazardous food meets 4 26 Food-contact surfaces of utensils& 2 44 Floors:floor covering installed,
temperature requirements during storage, equipment clean constructed as required,good repair,clean
preparation,display,service,and
transportation 27 Nonfood-contact surfaces of utensils& 1 45 Floors,graded,drained as required 1
equipment clean 46 Floor,wall juncture covered
4 Adequate facilities to maintain product 2 28 Equipment/utensils,storage,handling 1 47 Mats removable,good repair,clean
temperature thermometers rovided
5 Potentially hazardous food properly thawed 2 48 Exterior walking,driving surfaces, 1
6 Unwrapped or potentially hazardous food 4 WATER SUPPLY good repair,clean
not reserved F30
Water source adequate,safe
q 4 49 Walls,ceilings attached,equipment properly 1
7 Food protected during storage,preparation, Hot and cold water under pressure, 2 constructed,good repair,clean. Wall&ceiling
display,service&transportation 2 provided as required surfaces as required.
8 Food containers stored off floor 50 Dustless cleaning methods used, 1
SEWAGE DISPOSAL cleaning equipment properly stored
9 Handling of food minimized 2 R31SSewagedisposal approved 410 Food dispensing utensils properly stored 1 sposal of waste water 1 LIGHTING&VENTILATION
11 Toxic items properly stored,labeled,used 14 51 Adequate lighting provided as required 1
PLUMBING 52 Room free of steam,smoke odors 1
PERSONNEL F34
FINoo
ation,installation,maintenance 1 53 Room&equipment hoods,ducts,vented as required
12 Personnel with infection restricted 4 cross connection,back siphonage,backflow 4
DRESSING ROOMS&LOCKERS
CLEANLINESS OF PERSONNEL TOILET FACILITIES 54 Rooms adequate,clean,adequate lockers 1
13 Handwashing facilities provided, 4 35 Adequate,convenient,accessible,designed, 4 provided,facilities clean
personnel hands washed clean installed
14 Clean outer clothes,effective hair restraints 1 36 Toilet rooms enclosed with self-closing door 1
15 Good hygienic practices,smoking restricted 2 37 Proper fixtures provided,good repair,clean HOUSEKEEPING
55 Establishment and premises free of litter,no 1
EQUIPMENT&UTENSILS: DESIGN, HANDWASHING FACILITIES insect/rodent harborage,no unnecessary articles
CONSTRUCTION &INSTALLATION 38 Suitable hand cleaner and sanitary towels or 1 56 Complete separation from living/sleeping quarters 1
16 Food-contact surfaces designed,constructed, 2 approved hand drying devices provided, and laundry
maintained,installed,located tissue waste receptacles provided
57 Clean/soiled linens stored properly 1
17 Nonfood-contact surfaces designed, 1 58 1 No live birds,turtles,or other animals 1
constructed,maintained,installed,located GARBAGEIRUBBISH STORAGE&DISPOSAL (except guide dogs)
18 Single service articles,storage,dispensing 2 39 Approved containers,adequate number, 1
19 No reuse of single service article covered,rodent proof,clean NONSMOKING AREAS
20 Dishwashing facilities approved design,adequately j
40 Storage area/rooms,enclosures- 59 1 Seats 75 or more:Nonsmoking area provided, 3
constructed,maintained,installed,located properly constructed,clean sign(s)posted at entrance(s),smoking area
1 indicated by sign(s)
41 Garbage disposed of in an approved manner,
at approved frequency QUALIFIED FOOD OPERATOR
DEMERIT SCORE 60 Qualified Food Operator 3
4 — 3 _ 2 1^ RISK FACTORVIOLATIONS IN RED 61 Designated alternate 2
d� J. 62 Written documentation of training program 2
TOTAL RATING Date Corrections Due Sig atuof Person in har
ne
3 VAy� SIGNE or
DESCRIBE DEFIC ON CONTINUATION SHEETS
Page of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET Gaga
eV
NAME OF ESTABLISHMENT LWN7-_'SbW1.,0;rc,"&,_.jp Ct40f£L DATE OF INSPECTION
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INSPECTION REMARKS
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INITIAL(INSPECTOR) 7_7 INITIAL(PERSON IN CHARGE)
Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager
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Establishment: `> e.�sb �o���.— Date of Inspection: is
ddress: sow T%T Owner or Operator:
ADDITIONAL FOUR POINT ITEMS f0i KEY: DNC [DOES NOT COMPLY]
6 Foods not re-served. 4 31 Sewage disposal approved.
-Unwrapped foods not re-served -Operating as required 4
-Potentially hazardous foods not re-served' b
11 Toxic chemicals. 34
No cross connections,back siphonage,backflow
-Stored properly,labeled properly,used properly Proper type/installation/backflow prevention device/air gap for:
-Sanitizer concentration not to exceed maximum permitted -Food equipment -Hose connections -Dish machines
-No unnecessary toxics on the premises -Soda system carbonator -Beverage dispensers -Toilet tanks
-Pesticides/rodenticides properly dispensed -Chemical dispensers -Ice machines
Proper drain for:
29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines
-Well/well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible,
-Water quality in compliance designed,properly installed
-Monitoring in compliance
OTHER ITEMS KEY: DNC [DOES NOT COMPLY]
2 Sources of food:Original container,properly labeled 40 Garbage/rubbish storage area/rooms,enclosures-properly constructed,dean
TI.Potentially hazardous food properly thawed 41 Garbage/rubbish disposed of in an approved manner,at approved frequency
10 Food dispensing utensils properly stored 42 Vermin Control: No insects/rodents present
od worker:Clean outer clothes,effective hair restraints 3 Outer openings protected against entrance ofinsects/rodents
4 Floors:Floor covering installed,constructed as required,good repair,clean
16 Food-contact surfaces designed,constructed,maintained,installed, 45 Floors graded,drained as required
located
6 Floor,wall juncture covered
17 Nonfood-contact surfaces designed,constructed,maintained, 7 Mats removable,good repair,clean
installed,located
8 Exterior walking,driving surfaces,good repair,clean
18 Single service articles,storage,dispensing
19 No reuse of single service article 9 lls,ceilings attached,equipment properly constructed,good
20 Dishwashing facilities approved design,adequately constructed, repair,clean.Wall&ceiling surfaces as required
maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored
Equipment&Utensils: Cleanliness 51 Adequate lighting provided as required
21 Preflushed,scraped,soaked and racked 52 om free of steam,smoke odors
22 Wash water clean,proper temperature �050ms&equipment hoods,ducts,vented as required
23 Accurate thermometers provided,dish basket,if used onfood contact surfaces of utensils&equipment clean 54 Rooms adequate,clean,adequate lockers provided,facilities clean
55 Establishment and premises free of litter,no insect/rodent harborage,
28 Equipment/utensils,storage,handling no unnecessary articles
32 Proper disposal of wastewater 56 Complete separation from living/sleeping quarters and laundry
33 Plumbing location,installation,maintenance 57 Clean/soiled linens stored properly
36 Toilet rooms enclosed with self-closing door 58 No live birds,turtles,or other animals(except guide dogs)
37 Proper toilet fixtures provided,good repair,clean
59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at
entrance(s),smoking area indicated by sign(s)
39 Approved garbage/rubbish contain s, dequate number,covered,
rodent proof,clean Routine Inspection ❑Reinspection 0 Preoperational Inspection
INSPECTOR:T R: Other Inspection:
Demerit Score: *Include demerits from page 1
t 4 3 2 1 Total Rating
signature ture
S V 4 I'J In.. 1 �O
print name int name
(o!64.Zst t X 2 �47 S - DATE CORRECTIONS DUE:
phone number ti le
Page 2 of 2 plus_ continuatiot pages Focused Inspec tion 1/2002
i
Establishment: pry o6s �a�1 r—r, c Inspection Date: � �, Time: [ns -RE]nsp
Address/City: �a<v F;,c g3wt� a—r-, Health Dept: Sgm,,TNA :,�.rt,�4 Class: 1 2
Based on an inspection this day,the items marked DNC identify the violations in operation or facilities which must be corrected by the date specified on page 2.
RISK FACTOR ITEMS: Listing is not inclusive of all possible debitable items C WO N/A IDNC } Y_: C[complies] NIO[not observed] NIA[not applicable]
3 DNC[does not comply] 0[other] RTE[ready-to-eat]
2
A Food workers have no exposed infected lesions/burns
2
B Personnel with infection restricted
- � "-�' C Communicable disease of worker reported to local health director
A Approved shellfish,finfish,meat&poultryUSDA approved 00
B Food cans in good condition(not dented,rusty,bloated,leaking) Handwash facilities in all food prep/dispensing&warewash areas
C Wholesome/nonadulteratedfoods/safe B Handwash facilities in or immediately adjacent to toilet rooms
D Commercial products(no home grown/canned food) C Handwash facilities accessible/convenient to use
E Potentially hazardous foods received at proper temperature D Personnel hands washed,clean/Proper handwash procedure
E Handwashing at appropriate times
0
A Hot holding greater than or equal to 140°F. (Whole beef/pork roasts 1300 F.) A ❑ No eating ❑ No smoking while working
B Cold holding less than or equal to 450F. B I Wounds covered adequately
C Proper cooling C Proper sink used for handwashing
D Proper re-heating 0
E Proper internal cooking/consumer advisory posted
0 A Approved sanitizeravailable/adequateconcentrationofsanitizer
B Food-contact surfaces and utensils used for potentially
hazardous food sanitized at least every 4 hours /
A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp
B Proper food thermometer for product
D Propersanitizin procedure
C Thermometers appropriately placed in cooler units
E Sanitizing between raw animal origin&ready-to-eat food
0 0
A Cloths and/or sponges in good repair and clean l
A Produce washed
B Wiping cloths kept in sanitizer between uses
0
B Raw meats not stored/prepared near ready-to-eat foods
C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean
D Adequate splash guards/sneeze guard B Single use gloves changed when soiled
E No unauthorized personnel 1100C Food--contact surfaces clean
F No pooling of eggs not cooked immediately
8 Food containers stored off the floor
0
A No unnecessary handling RTE and/or cooked foods with bare hands A Soap/paper towels/ drying device available
B Dispenser(s)working: ❑Soap ❑Papertowel
B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sink(s)clean/waste receptacle at handwash sink
C Adequate utensil(s)fordispensing food/ice 0
0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS
The following information is not debitable and does not affect your score. -KEY: QFO[qualified food operator],DA[designated alternate],PHF[potentially hazardous food],FB[foodborne]
PHFs are hot held at: OF. PHFs are cold held at: F. Describe illness conditions when you would exclude a food worker from working:
Are internal cooking temperatures taken? Y N *To what temperature do you cook:
Poultry Ground Beef Pork What diseases related to FB illness are you required to report to the local health department?
Roasts Other
Describe re-heating procedures: Is there a written illness policy that requires the food worker to report specific illness conditions
Are temperatures recorded/logged for cold holding foods/equipment? Y N and diseases to the QFO? Y N *Do you have a paid sick leave policy? Y N
Are foods cooked in advance and cooled? Y N *Are leftovers saved? Y N Is there a language barrier between inspector&QFO? Y N ff-M indicate language spoken
List products cooled: by QFO/DA: *Can the QFO/DA read the inspection report? Y N
Describe cooling methods: Indicate who answered the above questions:Name(print):
Indicate the title of above person(circle all that apply):QFO DA Mgr Cook Owner FW
Is cooling monitored for time&temp? Y N Is the monitoring of cooling recorded? Y N .Obtain signature of the person who received the QFO responsibilities information at the time of the
Is there a produce washing policy? Y N *Describe what is washed and inspection:
where: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2
Page of
INSPECTION REPORT STATE OF CONNECTICUT
FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH
CONTINUATION SHEET
NAME OF ESTABLISHMENT TOWN o DATE OF INSPECTION
INSPECTION
FORM# REMARKS
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INITIAL(INSPECTOR) (VN. INITIAL(PERSON IN CHARGE)
Distribution: lst-White-Health Department 2nd-Yellow-Owner/Manager
Date of Inspection: t Z L
tltlress: - � jlw � '�-L,z.`- i3�✓ Owner or Operator:
ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY]
6 Foods not re-served.
-Unwrapped foods not re served 4: 31 Sewage disposal approved.
-Potentially hazardous foods not re-served -Operating as required
No cross connections,back siphonage,backflow
11 Toxic chemicals. Proper type/installation/backflow prevention device/air gap for:
-Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines
-Sanitizer concentration not to exceed maximum permitted-No unnecessary toxics on the premises -Soda system carbonator -Beverage dispensers -Toilet tanks
-Chemical dispensers -Ice machines
-Pesticides/rodenticides properly dispensed Proper drain for:
29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines
-Well/well head protected from contamination 35-Water quality in compliance Toilet facilities. Adequate,convenient,accessible,
-Monitoring in compliance designed,properly installed
OTHER ITEMS KEY: DNC [DOES NOT COMPLY]
2 Sources of food: Original container,properly labeled 40 Garbage/rubbish storage area/rooms,enclosures-property constructed,clean
5 Potentially hazardous food properly thawed 41 Garbage/rubbish disposed of in an approved manner,at approved frequency
1 d dispensing utensils properly stored 42 min Control: No insects/rodents present
4 dworker:Clean outer clothes,effec' a hair restraints 43 Outer openings protected against entrance of insects/rodents
4 Floors: Floor covering installed,constructed as required,good repair,clean
16 Food-contact surfaces designed,constructed,maintained,installed, 45 Floors graded,drained as required
located
6 Floor,wall juncture covered
17 Nonfood-contact surfaces designed,constructed,maintained, 7 Mats removable,good repair,clean
installed,located
8 Exterior walking,driving surfaces,good repair,clean
18 Single service articles,storage,dispensing
19 No reuse of single service article 9 ffils,ceilings attached,equipment properly constructed,good
20 Dishwashing facilities approved design,adequately constructed, repair,clean.Wall&ceiling surfaces as required
maintained installed located 50 Dustless cleaning methods used,cleaning equipment properlystored
Equipment&Utensils: Cleanliness 51 Adequate lighting provided as required
21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors
water clean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required
2 curate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean
7 food-contact surfaces of utensils&equipment clean 55 Establishment and premises free of litter,no insect/rodent harborage,
8 Equipment/utensils,storage,handling no unnecessary articles
32 Proper disposal of wastewater 56 Complete separation from living/sleeping quarters and laundry
33 Plumbing location,installation,maintenance 57 Clean/soiled linens stored properly
36 Toilet rooms enclosed with self-closing door 58 No live birds,turtles,or other animals(except guide dogs)
59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at
37 Propertoiletfixturesprovirted,good repair,clean entrance(s),smoking area indicated by sign(s)
39 Approved garbage/rubbish contain , equate number,covered,
rodent proof,clean 1PRoutine Inspection OReinspection 0 Preoperational Inspection
Inspection:
INSPECTOR. j� All rbtbp Demerit Score: *Include demerits from page 1
4 3 2 1 Total Rating
signature Itture
pr' t name print name
phone n b,r title DATE CORRECTIONS DUE:
/ � J�`"� Page 2 of 2 plus�_continuation pages FocusedInspectlon 1/2002
Establishment: Inspection Date: > r L,;, ® Time: Einsp
Address/City: ,ss r -ter, -k-�s �nT� ;3ti,✓�j Health Dept: V'j r����„ class; 1 2&
Based on an inspection this day,the items marked DNC identify the violations in operation or facilities which must be corrected by the date specified on page 2.
RISK FACTOR ITEMS:Listing is not inclusive of all possible debitable items C N/0 N/A JDNC I I KEY: C[complies] N/O[not observed] NIA[not applicable]
/
3 DNC[does not comply] 0[other] RTE[ready-to-eat]
no iiR �fur
NQ ( A 461 tesga 'lt 2 t '
69 VWA n doc entatfon of t aini g,pragfa A Food workers have no exposed infected lesions I burns
2 B Personnel with infection restricted
1 App[orred SE3gKc8,udtotesonle,gtinadyltel C N/0 WA 4 q. ommunicable disease of worker reported to local health director
A Approved shellfish,finfish,meat&poultry USDA approved 13 `H fa Yitie pro�tided,handswasf�tt,clean C ITO 4 '
B Food cans in good condition(not dented,rusty,bloated,leaking) Handwash facilities in all food prep/dispensing&warewash areas
C Wholesome/nonatlulteratedfoods/safe B Handwash facilities in or immediately adjacent to toilet rooms
D Commercial products(no home grown/canned food) C Handwash facilities accessible/convenient to use
E Potentially hazardous foods received at proper temperature D Personnel hands washed,clean/Proper handwash procedure
0
E Handwashing at appropriate times
77
y 0
C iVIO NIA 2
A Hot holding greater than or equal to 1400F. (whole beef/pork roasts 1300 r.) A ❑ No eating ❑ No smoking while working
B Cold holding less than or equal to 450F. B Wounds covered adequately
C Proper Cooling C Proper sink used for handwashing
D Proper re-heating 'oo0
E Proper internal cooking/consumer advisory posted r Ott
-
rZs1ZC of' 1 56C4_1:11WA Approved sanitizer available/adequate concentration of sanitizer
r t Food-contact surfaces and utensils used for potentially
hazardous food sanitized at least every 4 hours
.."
A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp
B Proper food thermometer for product
_L Proper sanitizing procedure 00
00 E Sanitizing between raw animal origin&ready-to-eat food
C Thermometers appropriately placed in cooler units O
0
Cloths and/or sponges in good repair and clean
A Produce washed
B Wiping cloths kept in sanitizer between uses
B Raw meats not stored/prepared near ready-to-eat foods
C Food covered properly Food equipment clean,utensils clean,equipment interiors clean
D Adequate splash guards/sneeze guard 1100,
B Single use gloves changed when soiled
E No unauthorized personnel C Food--contact surfaces clean
F No pooling of eggs not cooked immediately 0
8 Food containers stored off the floor
1 L
oe
` I /
No unnecessary handling RTE and/or cooked foods with A Soap paper towels drying device available bare hands B
Dispenser(s)working: ❑Soap ❑Paper towel
B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sink(s)clean I waste receptacle at handwash sink
C Adequate utensil(s)fordispensing food/ice 0
if!r�
0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS
The following information is not debitable and does not affect your score. J9 Y: QFO[qualified food operator],DA[designated alternate],PHF[potentially hazardous food],FB[foodbome]
PHFs are hot held at: IF. PHFs are cold held at: F. Describe illness conditions when you would exclude a food worker from working:
Are internal cooking temperatures taken? Y N *To what temperature do you cook:
Poultry Ground Beef Pork
Roasts Other What diseases related to FB illness are you required to report to the local health department?
Describe re-heating procedures: Is there a written illness policy that requires the food worker to report specific illness conditions
Are temperatures recordedllogged for cold holding foods/equipment? Y N and diseases to the QFO? Y N *Do you have a paid sick leave policy? Y N
Are foods cooked in advance and cooled? Y N *Are leftovers saved? Y N Is there a language barrier between inspector&QFO? Y N If yes indicate language spoken
List products cooled: by QFO/DA: *Can the QFO/DA read the inspection report? Y N
Describe cooling methods: Indicate who answered the above questions: Name(print):
Indicate the title of above person(circle all that apply):QFO DA Mgr Cook Owner FW
Is cooling monitored for time&temp? Y N Is the monitoring of cooling recorded? Y N .Obtain signature of the person who received the QFO responsibilities information at the time of the
Is there a produce washing policy? Y N *Describe what is washed and inspection:
where: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2